ATLANTA -- Cases of the diseases that vaccines can prevent have fallen to an all-time low, CDC researchers have reported.

Action Points

Explain to interested patients that the historical comparison in this study reinforces the benefits of immunization.

Note that the reductions in disease rates and disease-specific death rates were high for most recommended vaccines.

ATLANTA, Nov. 14 -- Cases of the diseases that vaccines can prevent have fallen to an all-time low, CDC researchers have reported.

Cases of eight diseases for which a vaccine was licensed or recommended prior to 1980 fell by at least 99% or were eradicated in the U.S. by 2006, according to the comparison of current and historical disease rates reported in the Nov. 14 issue of the Journal of the American Medical Association.

Declines were 80% or greater for diseases targeted for nationwide vaccination since 1980, including hepatitis A, acute hepatitis B, invasive Haemophilus influenzae type b, and varicella, found Sandra W. Roush, M.T., M.P.H., of the CDC's National Center for Immunization and Respiratory Diseases here, and colleagues.

"Vaccines are among the greatest achievements of biomedical science and public health," they wrote.

Influenza was excluded from the analysis because it differs from other vaccine-preventable diseases in that the vaccine and virus change yearly, requiring an annual vaccination strategy.

The researchers used the most current data, typically for 2006, from the CDC's National Notifiable Diseases Surveillance Systems, the National Vital Statistics System, and other reporting agencies.

Pre-vaccine rates were taken from a variety of historical reporting sources.

Comparing case rates before national vaccination recommendations with those in 2006, declines were:

100% for diphtheria.

99.9% for measles.

100% for both paralytic and acute poliomyelitis.

99.9% for rubella.

99.3% for congenital rubella syndrome.

100% for smallpox.

95.9% for mumps.

92.9% for tetanus.

92.2% for pertussis.

Comparing death rates for each of these diseases likewise showed a large benefit of national vaccination programs. The reductions from the pre-vaccine period with 2006 included:

100% for diphtheria.

100% for measles.

100% for both paralytic and acute poliomyelitis.

100% for rubella.

100% for smallpox.

100% for mumps.

99.9% for tetanus.

99.3% for pertussis.

The advances were less complete for diseases with vaccines approved or recommended for use after 1980. Comparing the pre-vaccine period to 2006, the findings included:

Cases of invasive H. influenzae type b disease declined by at least 99.8% while deaths dropped by 99.5% or more.

For the newest vaccine among the bunch, invasive pneumococcal disease cases declined by 34.1% and deaths by 25.4% since 1997-1999.

"These achievements are largely due to reaching and maintaining high vaccine coverage levels from infancy throughout childhood by successful implementation of the infant and childhood immunization program," the researchers wrote.

They noted that vaccination with just seven of the 12 routinely recommended vaccines in childhood has been projected to save 33,000 lives and prevent 14 million cases of illness in every birth cohort.

But vaccine-preventable diseases have other societal and economic costs as well that add to the benefit, they said.

For every birth cohort, vaccination yields an additional $10 billion reduction in physician office visits, hospitalizations, and other direct costs as well as $33 billion less in indirect costs from disability, missed time from school, and lost productivity at work, they added.

"Continued efforts to improve the efficacy and safety of vaccines and vaccine coverage among all age groups will provide overall public health benefit," Dr. Roush and colleagues concluded.

However, the greatest benefit is likely to come from increasing vaccination rates among adolescents and adults, they said, particularly for the human papillomavirus and the newer pertussis, tetanus, and diphtheria vaccines.

The researchers were employees of the CDC when the study was conducted and prepared for publication. The authors reported no financial conflicts of interest.

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine

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